| Schizophrenia (adults)
Bipolar I disorder (acute/maintenance) View labelExact | Switching from olanzapine typically matches the prior oral olanzapine dose (e.g., 10 mg → 10/10 mg); olanzapine-naïve patients commonly start 5/10 mg or 10/10 mg once daily. | Combines olanzapine (D2/5-HT2A antagonist) with samidorphan, an opioid receptor antagonist intended to blunt olanzapine-associated weight gain. | CYP1A2, UGT1A4, CYP3A4 | Single-dose mean 30 h | No | | - Metabolic monitoring on an olanzapine-equivalent cadence (weight/BMI, waist, blood pressure, fasting glucose/A1c, lipids) at baseline and periodically; track lifestyle goals alongside labs.
- Opioid exposure prevention: medication reconciliation at every visit (prescription/OTC), with explicit counseling about dental/ER encounters and cough/cold products.
- Perioperative and emergency pain planning, including documenting an opioid-avoidance plan and ensuring the wallet card is carried and presented to clinicians.
- Sedation, orthostasis, and falls risk—reassess driving/occupational safety after dose changes and when other CNS depressants are added.
- Smoking status and CYP modulators (CYP1A2 inhibitors; CYP3A4 inhibitors/inducers) that can change exposure; reassess dose needs when smoking stops/starts.
- AIMS/EPS monitoring (akathisia, parkinsonism) at routine intervals, because movement risks remain similar to olanzapine.
| No | 2026-03-31 |
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| Schizophrenia; acute treatment of manic or mixed episodes (bipolar I) and maintenance; in combination with fluoxetine for bipolar depression. View labelExact | Schizophrenia (adults): initiate 5–10 mg once daily; titrate by 5 mg increments at ≥24-hour intervals to 10–20 mg/day (max 20 mg). | Antagonist at serotonin 5‑HT2A and dopamine D2 receptors; strong H1 and muscarinic activity. | CYP1A2, CYP2D6 (minor) | Steady-state mean 30 h | No | | - Metabolic monitoring (weight/BMI, waist circumference, blood pressure, fasting glucose/A1c, lipids) at baseline and periodically (early and then ongoing) because weight and glycemic changes can occur quickly.
- Appetite changes, sedation, and falls risk—reassess driving and occupational safety after dose changes and when other CNS depressants are added.
- Smoking status and CYP1A2 modulators; reduce dose when smoking stops and reassess if smoking restarts or if CYP1A2 inhibitors are introduced.
- AIMS/EPS monitoring at routine intervals, especially in older adults and at higher doses (EPS risk is lower than FGAs but not zero).
- For depot olanzapine pamoate, adhere to REMS observation and PDSS counseling requirements, including post-injection monitoring and “no driving” instructions on injection day.
| q2–4wk | 2025-12-28 |
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| Schizophrenia; depressive episodes associated with bipolar I or II disorder; adjunctive treatment of major depressive disorder. View labelExact | Schizophrenia, bipolar depression, and adjunctive major depressive disorder: 42 mg orally once daily with or without food; no titration required. | 5‑HT2A antagonism; D2 presynaptic partial agonist and postsynaptic antagonist; SERT inhibition. | Multiple CYPs | Steady-state mean 18 h | No | | - Metabolic: weight/BMI, fasting glucose/HbA1c, and lipids (baseline and periodic).
- Sedation: assess next-day impairment and fall risk, especially with other sedatives.
| No | 2025-12-29 |
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